Multiple sclerosis and chronic cerebrospinal venous insufficiency: a critical review.

Baton Rouge Neurology Associates, Baton Rouge General Medical Center, 3600 Florida Blvd, Baton Rouge, LA 70806, USA.
Therapeutic Advances in Neurological Disorders 07/2011; 4(4):231-5. DOI: 10.1177/1756285611405565
Source: PubMed

ABSTRACT Chronic cerebrospinal venous insufficiency (CCSVI) was recently proposed as a contributing factor in the pathology of multiple sclerosis. This concept has gained remarkable attention, partly because endovascular neurointervention has been suggested as a treatment strategy. This review summarizes available evidence and provides a critical analysis of the published data. Currently, there is inconclusive evidence to support CCSVI as an etiological factor in patients with multiple sclerosis. Endovascular procedures should not be undertaken outside of controlled clinical trials.

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    ABSTRACT: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by morphological alterations involving efferent cerebral vascular paths. CCSVI has been implicated as a contributing factor to multiple sclerosis (MS) but this theory is highly controversial. We report three cases of CCSVI patients with MS who had undergone internal jugular veins (IJVs) angioplasty to restore vessels patency. All patients reported significant symptomatic improvement after angioplasty until symptoms recurred following restenosis of the treated IJVs. Surgical IJVs reconstruction was performed. Patients’ symptoms gradually improved and the benefits were maintained at the one-year follow up
    Annals of Vascular Surgery 10/2014; · 1.03 Impact Factor
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    ABSTRACT: Objective: The purpose of this study is to evaluate the relationship between Atlas vertebra misalignments identified via radiographs and patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI). Clinical Features: Four patients with MS and CCVSI, three women and one man were evaluated according to revised McDonald criteria. These four patients were compared to a control group of four patients of similar age but with no neuro-degenerative diseases. Intervention and Outcomes: This is the first report on Atlas (C1) misalignment in MS patients with CCVSI. Four patients were evaluated using the Zamboni's criteria using the following: Echo Color Doppler (ECD) MyLab Vinco System Esaote, Upper cervical x-ray examination, Myofunctional Map, and Tytron thermal scanning instrumentation. In this study we found different alterations of C1 alignment in the MS patients versus the control group. Analysis of the x-ray examination permits us to identify a severe rotation and anterior intrusion of C1 in the MS patients with CCVSI. Conclusion: We found not only endovenous congenital malformations, but also external venous compression that blocks drainage flow. This confirms the validity of our Mechanical Posture Vascular Compressive Block. We hypothesize that extracranial venous compression is linked to severe misalignment of C1. We can also catalogue misalignments into two types of degrees: moderate and severe. This staging permits us to begin to distinguish paraphysiological misalignments from true pathological misalignments.
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    ABSTRACT: BACKGROUND AND PURPOSE:Chronic cerebrospinal venous insufficiency is a postulated etiologic factor for multiple sclerosis, but the higher frequency with longer disease duration and progressive disability suggests that chronic cerebrospinal venous insufficiency is secondary to chronic disease. We evaluated the presence of chronic cerebrospinal venous insufficiency in pediatric-onset MS.MATERIALS AND METHODS:Twenty-six pediatric patients with MS (18 years of age or younger), 26 age-matched healthy controls, and 13 young adults with pediatric-onset MS underwent sonography of the internal jugular, vertebral, and deep cerebral veins. Five venous hemodynamic criteria were assessed, with 2 criteria required for chronic cerebrospinal venous insufficiency. MR imaging studies, performed in the pediatric patients with MS and healthy control groups, included intracranial 2D time-of-flight MR venography and velocity-sensitive phase-contrast sequences. Contrast-enhanced brain MR images were obtained in pediatric patients with MS to further evaluate venous patency. We used paired t tests, Wilcoxon matched pairs, McNemar tests, and exact conditional logistic regression to estimate the association of chronic cerebrospinal venous insufficiency with MS.RESULTS:Fifty participants (73.5%) had normal ultrasound findings, 15 (23.1%) met 1 venous hemodynamic criterion, and 2 pediatric patients with MS and 1 young adult with pediatric-onset MS met chronic cerebrospinal venous insufficiency criteria. Chronic cerebrospinal venous insufficiency was not associated with MS (odds ratio, 2.41; 95% CI, 0.19-infinity). Demographic and disease characteristics did not differ between the patients with MS meeting chronic cerebrospinal venous insufficiency criteria (n = 3) and those who did not (n = 36; all, P > .05). The mean (SD) MR imaging measures of intracerebral flow did not differ between the 2 pediatric patients with MS meeting chronic cerebrospinal venous insufficiency criteria (0.85 ± 0.11) and healthy controls (0.87 ± 0.16, P = .50); no child demonstrated venous obstruction.CONCLUSIONS:Chronic cerebrospinal venous insufficiency is rarely observed in children or young adults with pediatric-onset MS. Venous anatomy and flow rates indicate that venous outflow is intact in pediatric patients with MS. Our findings argue against chronic cerebrospinal venous insufficiency as a component of MS etiology.
    American Journal of Neuroradiology 07/2013; · 3.17 Impact Factor

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